Updated May 10 at 2:21 p.m.

Last year, a record-setting 210 Vermonters died from opioid overdose, according to state data released in April. Overdose deaths were 33% higher than the previous year.

Harm reduction programs and mental health agencies are expected to receive increased funding in this year’s budget. But as the Vermont Legislature nears adjournment, some advocates and a few senators are concerned that the policy approaches to substance use remain largely unchanged. 

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Some are also frustrated that options such as overdose prevention sites and changes to Medicaid rules were stripped from proposals. 

“It’s abundantly clear that the time is now,” said Ed Baker, who co-chairs the Vermont Overdose Prevention Network and is in recovery from injection drug use. “The velocity of overdose death in Vermont is unparalleled. There’s no reason to think that will change. The need could not be more urgent.” 

Two opioid-related bills await the governor’s signature. 

H.728, the opioid response services bill, passed both chambers Monday but no longer contains any funding. (The other bill, H.711, would create a committee to distribute Vermont’s cut of opioid settlement money from pharmaceutical manufacturers and distributors and the Sackler family.)

Sen. Ruth Hardy, D-Addison, said the Senate removed funding from H.728 for pilot programs like mobile medication assisted treatment after the Department of Health testified that those programs were already in place or in progress and had federal funding. 

But Jay Diaz, general counsel for the ACLU of Vermont, disagreed that federal funding was up to the task. 

“We should not be satisfied with the status quo,” Diaz said. “Even if we're getting some amount of federal money, we should be putting as much as we can into this.”

Some of the bill’s policy changes proposed earlier in the session were reduced to requests for reports: on relaxing prior authorization rules for medications like Suboxone, on mobile medication assisted treatment, on other current programs run by the health department or Department of Corrections. 

Overdose prevention sites — places where people can use drugs without fear of arrest and with medical supervision to intervene if they overdose — were a main point of contention when the bill was discussed on the Senate floor last week. 

The bill would commission a working group to conduct a feasibility study and cost estimate on opening an overdose prevention site in Vermont — something Sen. Chris Pearson, P/D-Chittenden, argued the state needs now.

“How many more Vermonters will die while we continue to study whether or not this proven response to an opioid overdose crisis is suitable for Vermont?” Pearson said on the Senate floor last week. “It’s very frustrating. I’m running out of patience.”

This would be Vermont’s third major, public study on overdose prevention sites. In 2017, Chittenden County State's Attorney Sarah George organized a commission of law enforcement and health professionals who endorsed the idea. 

Enthusiasm cooled, however, when then-U.S. Attorney Christina Nolan, who is now running for U.S. Senate as a Republican, threatened to prosecute and seize the assets of anyone who tried to open such a facility. In 2018, the Vermont Opioid Coordination Council filed a report to the Legislature that was generally unfavorable of such a site. 

Hardy, who presented the bill on the Senate floor, echoed Pearson’s frustration, but she hopes this year’s working group will be different, she said, and more “action-oriented.” The working group would be required to examine the feasibility of such a site, and the state’s potential liability. 

“I wish we could have done more,” Hardy said in an interview. “This is clearly a huge crisis in our state, and we've bent over backwards — as we should have — for Covid, to keep people safe from Covid. But meanwhile, we're not bending over backwards to keep people safe from opioid addiction and overdoses. And so that's frustrating.”

Since the first study in 2017, legally sanctioned overdose prevention sites have opened in New York City. Hardy said that she hopes these examples will increase political willpower to try something similar in Vermont. 

For Theresa Vezina, executive director of Vermont Cares, it was heartening to see the Legislature supporting harm reduction programs at all, she said. Twenty years ago, syringe exchange programs were taboo, and met with “not in my backyard,” she said. 

Vezina didn’t always see eye-to-eye with the Legislature on what expanded services should look like, she said. Lawmakers suggested new pilot programs, but she urged greater investment in existing harm reduction infrastructure, she said. 

Because of federal rules, providers like Vermont Cares can’t use federal funding to buy harm reduction supplies, such as sterile syringes. About half of Vermont Cares’ funding comes from state health department grants, and the rest they make up with private fundraising — which got more difficult during the pandemic, Vezina said, even as the demand for their services grew. 

The number of people they serve has doubled since the start of the pandemic, Vezina said, and now totals more than 1,700 people across 11 Vermont counties. Over the past year, they’ve distributed more than 700,000 sterile syringes. 

But while demand grew, so did their operational costs. The cost of syringes has gone up 30% in the last year, Vezina said. Sometimes they’ve had to limit the number of syringes people can take to ensure there’s enough to go around. 

Syringe exchanges and other harm reduction programs are getting some increased support in the state budget, the details of which were still being finalized as of Monday afternoon. Designated agencies that provide mental health and substance use services are expected to receive an 8% rate increase.

The Legislature advanced one other policy bill related to the overdose crisis, H.711, which creates a panel to distribute Vermont’s cut of settlement money from opioid-related lawsuits. 

Vermont’s portion of the settlement payouts is expected to total about $84 million, said Sen. Ginny Lyons, D-Chittenden, who chairs the Senate Health and Welfare Committee. Those funds won’t be available until 2023, Lyons said. 

“I would hope that there wouldn't be significant criticism out there about what we haven't done, but rather really looking at what we have done,” Lyons said in an interview. “Because the policies and the reporting back that that's in (H.728) is going to bring information that we need, in order to spend the $84 million, or that portion of it.”

Andrew Seaman, a Montpelier-based addiction medicine physician and researcher, was disappointed the Legislature didn’t take up reforms on prior authorization for medication-assisted treatment. 

Prior authorization for Medicaid patients discourages some people from entering treatment, either because of delays or because they can’t get certain medications, Seaman said. 

According to state data, prior authorization for medication treatments takes 30 minutes, on average. But Seaman said in his experience working with patients, the approval process can sometimes take hours to days. If a patient is experiencing homelessness, or doesn’t have consistent phone access, it’s hard for him to follow up when insurance approval comes through. 

Any momentum to change the prior authorization process stalled earlier this session when lawmakers saw the cost estimate. 

​​Analysis by the Joint Fiscal Office found that changing the prior authorization process would cost the state between $17 million and $35 million. This was partially because analysts expected more people would use more expensive medications, like Sublocade, which costs more than $20,000 per person, per year. The state also would lose supplemental rebates, according to the Department of Vermont Health Access. 

“I am frustrated. I have a lot of empathy, or I should say compassion, for legislators,” Seaman said. “But I think legislative leadership should have been more courageous in pushing through bigger changes and not falling back on reports.”

Baker said he feels a bit jaded about what these studies will actually accomplish. He intends to make a “full court press” on the state to establish an overdose prevention site, he said, as he sees this as the last big harm reduction policy the state has yet to endorse. 

“When you look at it, there's all this good we've done,” Baker said. “But if you're talking to people on the street, working with people who are injecting drugs, you can't get away from it: We're not doing enough. That good has become like the enemy of the perfect, or the better.”

Clarification: An earlier version of this story imprecisely described the approval period for prior authorization for medication treatment as described by Andrew Seaman.

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Riley Robinson is a general assignment and multimedia reporter, covering stories across the state in writing, photos and video. She is a graduate of Northeastern University's School of Journalism and first joined the Digger newsroom as a Dow Jones News Fund intern.

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